# Assessment of the National Disease Surveillance System in The Gambia, January 2025: best practices and lessons learned

## TL;DR

This paper evaluates The Gambia's disease surveillance system, identifying strengths and areas needing improvement to enhance global health security.

## Contribution

The study provides a comprehensive assessment of The Gambia's national disease surveillance system, highlighting actionable insights for system strengthening.

## Key findings

- National surveillance guidelines were available in 66% of health facilities.
- Only 20% of facilities analyzed data by person, indicating gaps in data analysis capacity.
- No budget line for surveillance or epidemic response was found at the central level.

## Abstract

the global trend of emerging and re-emerging diseases has highlighted surveillance as a fundamental pillar in ensuring global health security. The Gambia undertook a surveillance system assessment as part of a structured approach for surveillance system strengthening. We describe the best practices, key gaps, and critically analyse the system’s capacity to collect complete, timely, and accurate data and the use of data for meaningful decision making.

we conducted a retrospective cross-sectional study to assess both core and supporting surveillance functions. A total of 74 public and private health facilities, comprising 16 hospitals and 58 primary health care facilities from rural and urban settings, were randomly sampled from a sampling frame of 195 facilities. Data were collected by MoH staff from both central and regional levels with support from officers from the WHO Country Office. Frequency distribution tables were prepared, and proportions were calculated, stratified by region and health facility levels.

national surveillance guidelines were available in 66% of the health facilities. Standard case definitions for priority diseases were present in 91% of the health facilities. More than half (66%) of the health facilities could handle specimens until shipment. Overall, 20%, 32% and 42% of the health facilities analysed data by person, place, and time, respectively. All regions had demonstrated the capacity to transport samples to a higher-level laboratory. At the central level, there was no budget line for surveillance or epidemic response.

investments in emergency preparedness and response mechanisms, building workforce capacity, and strengthening sample collection and transportation were evident. However, gaps remain in data analysis, implementation of eIDSR, and preparedness planning. Improving coordination, securing sustainable funding mechanisms, and implementation of EBS and CBS present key opportunities for system improvement.